Wednesday, March 28, 2012

If The Supremes Say No To Obamneycare, Then Go To Single Payer

So, the US Supreme Court seems likely to reject the individual mandate in Obamneycare, which would bring down the entire Affordable Care Act, even though the individual mandate was cooked up by the Heritage Foundation and was long the favored Republican plan, emphasizing using private insurance companies and individual responsibility not to be freeloaders on the system.

So, if the Supremes say no, just do what Teddy Kennedy proposed: expand Medicare to the entire population. This takes care of it, and we can get rid of Medicaid as well, which is increasingly an insufferable burden on the hard pressed state budgets (reminder that last year it was state and local governments that were laying people off to balance their budgets, the main source of rising unemployment in the US economy). So, go to single payer, which was better all along anyway.


Peter Dorman said...

I agree with you completely on the substance, Barkley, but this moniker "single payer" is a loser. Let's tell the world we have a great new idea, one that just appeared out of nowhere: Medicare for all!

Don Levit said...

It is interesting how people think that because Medicare is paid from taxes, that it is a terrific program to have and expand.
There are even people who believe that the trust fund is fully funded, so that there are no financial repercussions until the trust fund is exhausted.
There are also enough people who believe Medicare Part D is full funded to have a name for this outlook: the trust fund perspective. They believe Part D is fully funded, even though general revenues pay 75% of the premiums, and it is an immediate budget expense.
On the other hand, if you think new debt is as good as gold, due to the full faith and credit of the U.S. government, I can see the logic in a fully paid-up Part D.
Don Levit

Bruce Webb said...

Don your first two statements have no logical connection.

People like Medicare because it works for them, particularly in contrast to the previous system where few elderly folk had affordable access to medical care. If there was in fact a free market solution to this problem it did not in fact manifest itself prior to 1965, Medicare is as such properly seen as a governmental response to market failure. Just as the myriad reinsurance programs of the Federal government from FDIC and the Pension Guarantee Board to the direct insurance of the Federal Flood Insurance program are equal responses to similar private market failures. Certain categories of insurance either through their catastrophic nature (bank failures and major flood events) or their predictably high payout (medical care for the elderly) are just not suitable for private markets. And where there are exceptions, as for example Lloyd's of London's reliance on private 'Names' to provide maritime reinsurance, this is more due to the historical lack of jurisdiction of individual nations and so national markets over international waters. But if the high risk, high reward Lloyd's model was universally applicable we would not have had bank panics in the 1880s and ESP in the late 20s or as noted the horrible market failure that was medical insurance for the elderly prior to 1965. As it happened Medicare has a mixed set of funding mechanisms with Part A based on a pre-paid insurance model (similar to burial insurance) while Parts B and D operating on a 75/25 tax to premium ratio. But it is far from obvious that it is the financial structure of Parts B and D that make them any more popular than the essentially pre-paid structure of Part A. As usual you bring assertions where you need evidentiary arguments.

As to whether people think that Medicare is "fully funded" well most of those same people would probably think the military was "fully funded" even though the Pentagon has no Weapons Acquisition Trust Fund at all. Instead it is the belief that national defense is important enough that zero-ing out funding will never become an option. When we turn to Medicare the question is whether in the final analysis provisions of the General Welfare in the forms of medical care for the elderly are as important as the Common Defense of their nursing homes from foreign enemies. Oddly wealthy people who by and large can fund their own future medical care but can't afford their own private aircraft carriers and heavy tanks to protect their real property are willing to cost shift the costs of Common Defense outward while denying any responsibility for the General Welfare.

Which they smugly sum up as "The Virtue of Selfishness" while I tend to frame it as "Screw you Mac, I got mine. Including a bought and paid for legislature."

Or do you really believe your last sentence does not apply to the Defense budget? Does the Pentagon have access to Magic Fairy Gold of which I am unaware? If not you have a fairly twisted concept of Full Faith and Credit as it operates in a majoritarian society.

Bruce Webb said...

Not to mention that Part D does.not have a Trust Fund in the way that Part A (HI) does. The SMI Trust Fund is a purely accounting device in a way that HI isn't . Under law at least.

You might look up the concept of 'due diligence' as it relates to policy argumentation. You can hurt yourself much worse on an ill sharpened blade than a well maintained scalpel. And too often you are wielding a faintly rust spotted over used broad sword. Try a whetstone and some gun oil (a good enough substitute for your purposes)